title: Post-traumatic stress disorder and incidence of coronary heart disease: a twin study.
abstract: OBJECTIVE
  The aim of this study was to determine whether post-traumatic stress disorder (PTSD) is associated with coronary heart disease (CHD) using a prospective twin study design and objective measures of CHD.
  
  
  BACKGROUND
  It has long been hypothesized that PTSD increases the risk of CHD, but empirical evidence using objective measures is limited.
  
  
  METHODS
  We conducted a prospective study of middle-aged male twins from the Vietnam Era Twin Registry. Among twin pairs without self-reported CHD at baseline, we selected pairs discordant for a lifetime history of PTSD, pairs discordant for a lifetime history of major depression, and pairs without either condition. All underwent a clinic visit after a median follow-up of 13 years. Outcomes included clinical events (myocardial infarction, other hospitalizations for CHD and coronary revascularization) and quantitative measures of myocardial perfusion by [(13)N] ammonia positron emission tomography, including a stress total severity score and coronary flow reserve.
  
  
  RESULTS
  A total of 562 twins (281 pairs) with a mean age of 42.6 years at baseline were included in this study. The incidence of CHD was more than double in twins with PTSD (22.6%) than in those without PTSD (8.9%; p < 0.001). The association remained robust after adjusting for lifestyle factors, other risk factors for CHD, and major depression (odds ratio: 2.2; 95% confidence interval: 1.2 to 4.1). Stress total severity score was significantly higher (+95%, p = 0.001) and coronary flow reserve was lower (-0.21, p = 0.02) in twins with PTSD than in those without PTSD, denoting worse myocardial perfusion. Associations were only mildly attenuated in 117 twin pairs discordant for PTSD.
  
  
  CONCLUSIONS
  Among Vietnam-era veterans, PTSD is a risk factor for CHD.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. viola.vaccarino@emory.edu
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Jack
authors.initials: J
authors.lastname: Goldberg
authors.forename: Cherie
authors.initials: C
authors.lastname: Rooks
authors.forename: Amit J
authors.initials: AJ
authors.lastname: Shah
authors.forename: Emir
authors.initials: E
authors.lastname: Veledar
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Faber
authors.forename: John R
authors.initials: JR
authors.lastname: Votaw
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Forsberg
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Bremner
mesh_terms: D000328:Adult; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D004200:Diseases in Twins; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D014427:Twins / Q000706:statistics & numerical data*; D014429:Twins, Dizygotic; D014430:Twins, Monozygotic; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*; D047829:Vietnam Conflict
keywords: CFR; CHD; CI; DIS; DSM-III-R; Diagnostic Interview Schedule; Diagnostic and Statistical Manual of Mental Disorders-Third Edition-Revised; OR; PET; PTSD; STSS; cardiovascular diseases; confidence interval; coronary flow reserve; coronary heart disease; epidemiology; odds ratio; positron emission tomography; post-traumatic stress disorder; risk factors; stress; stress total severity score